Assessment of the Geriatric Patient: A Practical Approach

With the aging of the U.S. population, physicians are treating more persons aged 65 years and older in their practices. Many of these persons have limitations in their overall health and functioning as a result of physical, mental, or socioeconomic problems. Comprehensive geriatric assessment is a method of screening for and diagnosing physical and psychosocial impairment and functional disabilities in older persons. Such assessments are made in order to develop a comprehensive plan for prevention, treatment, and rehabilitation. The value of comprehensive geriatric assessment has been evaluated in inpatient, outpatient, and home settings and among programs that provide primary or consultative care. These studies have demonstrated that certain types of geriatric assessment programs can reduce mortality, are associated with a higher likelihood of living at home, and improve patients’ physical and cognitive functional status [1]. The domains that typically comprise the comprehensive evaluation of an older person include not only the traditional history and physical examination but also assessments of cognition and affect, functional status (ie, basic, instrumental, and advanced activities of daily living), the presence and extent of social support, economic status, safety of home environment, advance directives, and health-promoting and diseasepreventing behaviors and activities. The benefits of comprehensive assessment notwithstanding, when examining elderly patients it may seem impossible to identify and attend to the multiple problems that adversely affect their health and functioning. However, a variety of methods may be used to evaluate older patients efficiently without reducing the quality of care provided. In the following sections, we describe several brief screening and evaluation strategies to facilitate efficient assessment of the geriatric patient.